What is Rumination Syndrome?

Rumination Syndrome (RS) is a condition where people constantly regurgitate and either vomit or re-swallow their food or drink soon after eating. Although the syndrome was first described many years ago as occurring in young children with developmental disabilities, it is now recognized that the syndrome occurs in children and adolescents with intact cognitive abilities.

The diagnosis of rumination disorder does not require any formal diagnostic testing. There are specific diagnostic criteria that exist that help professionals make the diagnosis. The symptoms of Rumination Syndrome are:

At least a two-month history of repeated regurgitation and re-chewing or expulsion of food

The behavior begins soon after ingestion of a meal

The behavior does not occur during sleep

There is no retching

Symptoms do not respond to standard treatment for gastroesophageal reflux (GERD).

No evidence of an inflammatory, anatomic, metabolic or neoplastic process considered likely to be an explanation for the patient’s symptoms

While the symptoms listed above are common to patients with RS, each patient we see has a different presentation. In other words, the symptoms can look quite different person to person. While some patients vomit immediately after eating even one bite of food, others are able to eat a good deal of food before the rumination starts. Some patients feel pain with eating. Others feel nausea. Some patients do not report any sensations before the rumination begins.

RS falls into a category of GI conditions called Functional Gastrointestinal Disorders. As with any functional disorder, while no disease or physical abnormality is present, the patient is suffering from very real problems. The problems result from the interaction of many factors including nerve sensitivity, psychological stressors, or the way in which the brain and the GI system are interacting with one another.

Medical histories of patients with RS suggest that the symptoms often begin with some “triggering” event. This can be a viral infection, a GI disease, or even stress happening in the patient’s life. After this infection, event, or stress has gone away, the vomiting behavior remains in place, almost similar to a “habit.” As a consequence, when food or liquid enters the stomach, the body has learned a new behavior – contraction of the abdominal muscles – that results in pressure on the stomach and the food or fluid coming back up.

Impact on Quality of Life

While RS itself is not life-threatening, the problems that develop around the rumination are quite debilitating. Some of these problems include: